Provider Demographics
NPI:1275751562
Name:BOLAND, ANN MARIE (OTR)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:BOLAND
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COBLESKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12043-5144
Mailing Address - Country:US
Mailing Address - Phone:518-254-3207
Mailing Address - Fax:518-234-3335
Practice Address - Street 1:178 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-5144
Practice Address - Country:US
Practice Address - Phone:518-254-3207
Practice Address - Fax:518-234-3335
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008241-1225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand